Provider Demographics
NPI:1700823515
Name:KAMINSKY, KRISTI M (DPM)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:M
Last Name:KAMINSKY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 FIRE MESA ST STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-9009
Mailing Address - Country:US
Mailing Address - Phone:725-200-3242
Mailing Address - Fax:725-200-3244
Practice Address - Street 1:2435 FIRE MESA ST STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:725-200-3242
Practice Address - Fax:725-200-3244
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0902213ES0103X
IN07000844213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200161750AMedicaid
NVCF651YMedicare PIN
INU68566Medicare UPIN
NV6528080001Medicare NSC
IN0207020BMedicare ID - Type Unspecified